[Mesenterial infarct. New aspects of diagnosis and therapy].

Based on a retrospective analysis of 38 patients with mesenteric ischemia treated from 1981-1987, the current diagnostic and therapeutic concepts are presented. Embolic or thrombotic occlusions of the superior mesenteric artery prevailed (34 patients); venous thrombosis (4 patients) and non-occlusive disease (2 patients) occurred less frequent. Old age (70.6 years in average) and a long time interval between onset of symptoms and therapy (25.8 h in average) are responsible for the still high operative mortality (52.9% in the reported series). Of crucial importance is the early diagnosis within the first 6-12 hours, in which the ischemic bowel may mostly retain its viability. Since the application of transfemoral selective angiography or primary laparotomy however far more patients can be cured, compared to the results in earlier days. Especially in case of primary laparotomy the operative strategy aims in the exposition and inspection of the main trunk of the superior mesenteric artery and vein. Extensive ischemia of the intestines mandates, first of all, revascularization of the bowels. By means of exclusive vascular reconstruction or in combination with limited bowel resection (15 patients) the operative mortality could be reduced to 20%. For the intraoperative determination of intestinal viability the fluorescein test is of high reliability. New concepts in the management of mesenteric ischemia such as local arterial application of thrombolytics or spasmolytics open new approaches to improve the therapeutic results. Post-operative monitoring of serum-lactate in combination with clinical findings obviates routinely performed second-look operation.